Cardiovascular Risk Factors in Transgender Women Undergoing Long-Term Gender-Affirming Hormone Therapy: A Cross-Sectional Study

Introduction: Few data of long-term outcomes of cardiovascular (CVRF) risk factors of transgender women (TW) undergoing gender-affirming hormone therapy (GAHT) are available. Objectives: Evaluate CV risk factors after long-term GAHT in TW. Methods: A cross-sectional study was carried out with 8 TW (average age of 34.0 ±4.8 yo), 8 matched CM and 8 CW on age, body mass index (BMI) and activity level. All TW were non-gonadectomized subjects and were in estrogen [(E); transdermal estradiol (n=2), oral estradiol (n=3) and conjugated estrogen (n=3)] plus cyproterone acetate (CA) (n=8) therapy in an average time of 15.6 ±8.7 years. Results: Total Testosterone (ng/dL) level of TW, CW and CM were 83,5 (range 12,0-637,0), 20,5 (range 12,0-41,0) and 480,5 (range 264,0-843,0), respectively. It was similar between TW and CW (p=0,7284) and different in the comparison TWvsCM (p=0,0325). In TW group, the median of blood glucose was 84 mg / dL, HBA1c 5.1%, total cholesterol 146 mg / dL, HDLc 43 mg / dL, LDLc 89 mg / dL and triglycerides 81.5 mg / dL. In the comparison with other groups, there was no difference from the statistical point of view. It is necessary to emphasize the HDLc of TW (43 mg/dL) which was exactly the same of CM (p>0,999) and lower than CW (60 mg/dL)(p=0,0720). Systolic Blood Pressure (SBP)(mmHg) of TW (126±13) was higher than that of CW (95±11;p<0.001) and equal to that of CM (115±9;p=0.1489). Regards Diastolic Blood Pressure (DBP) (mmHg), the medians of TW, CW and CM were 80, 60 and 80, respectively, and in the comparison TWxCW p = 0.0070 and TWxCM p> 0.9999. Discussion: Youth TW (16.3 ± 1.4 yo) taking an average estradiol dose of 1.5 ± 1.0 mg/day, with an average AGHT duration of 12.3 ± 9.9 months matched to controls on age and BMI did have higher HDL than CW and TW participants were more insulin resistant than CM. About SBP of that youth TW (107 ± 12), it was lower than CW 113 ± 7 (p>0,05) and CM 116 ± 8 (p<0,001). Other previous study showed that after 6 months of estradiol use, in doses ranging from 2 to 8 mg daily glucose enhanced 6 mg/dL (from 86 to 92) as well as TC from 170 to 178 mg/dL, HDLc from 50 to 54 mg/dL, TGL from 102 to 115 mg/dL, and LDL did not change (93), while a systematic review and meta-analysis showed increased only in TG levels. SBP and DBP increased on average of 7,2 mmHg and 5,7 mmHg, respectively. Conclusion: Metabolic findings observed after the first few months of TW GAHT appear to remain at long term, except for HDLc. SBP and DBP appear to increase in the long term, after a drop initially observed.